Kevin Lathrop

Kevin Lathrop, president of TriZetto Provider Solutions, a Cognizant Company, writing in Physicians Practice, looks at the big challenges facing providers in 2018. Among his observations:

“The big question coming in 2018 is how will providers respond to the growing financial squeeze in the healthcare industry? The increasing pressure is political, economic and patient-based.

“Politics, value-based reimbursement, and patient collaboration will be important to providers in 2018. There will be ongoing financial challenges caused by shifts in politics and healthcare consumerism. More provider payments will be derived from patients, who are sometimes difficult to collect from, while payers likely will decrease payments through new and changing methodologies.

“Patients will continue to exert more pressure on providers as they advocate for new ways to pay bills, including user-friendly mobile and online payment options. Providers who respond swiftly may benefit from the political uncertainty and continued, increasing patient involvement in 2018.”

“Recently, the administration canceled payments to insurers intended to defray some costs for low-income Americans. In turn, many state attorneys general got involved to challenge what they viewed as a potentially negative impact.

“The payments were intended to help fund premiums and other healthcare-related expenses for some low-income Americans. The result could be more insurers leaving the ACA marketplace, increasing costs for taxpayers, fewer healthcare choices, and more changes.

“One immediate concern is that the financial crunch could trickle down to physicians who already contend with non-payment pressures.”

“Will these numbers increase as ACA subsidies decrease? It certainly seems possible, but only time will tell.”

“Value-based reimbursement (VBR) remains of interest to payers as they work with providers to make the shift from fee-for-service. Fostering quality care and positive health outcomes bode well for payers, providers and patients. For participating providers, VBR offers an opportunity to continue utilizing high-quality, outcome-driven treatments. VBR can also help providers address healthcare consumerism, when working closely with patients to promote and communicate positive health outcomes and encouraging patients to become part of the process.”

“Understanding of and acting on incoming and outgoing communications can help improve the efficacy of the provider practice and can play well with VBR.”